Oral steroids are just as effective as intravenous steroids in acute exacerbations of COPD

Report By: Dr Peter Hulme - SHO

Search checked by Craig Ferguson - SpR

Institution: Trafford General Hospital

Date Submitted: 21st June 2008

Date Completed: 3rd May 2011

Last Modified: 3rd June 2011

Status: Green (complete)

Three Part Question

In [patients with an acute exacerbation of COPD] are [intravenous or oral steroids] better at [reducing length of hospital admission and mortality]

Clinical Scenario

A 73yr old man with COPD is seen in the Emergency Department. You give him salbutamol and atrovent nebulisers but he remains breathless. You wonder whether giving intravenous or oral steroids would reduce length of hospital stay and his risk of death.

Search Strategy

EMBASE from 1980 to 2011 Week 08, Ovid MEDLINE 1948 to Feb Week 4 2011 with the following search strategy

((COPD OR coad).af OR (‘chronic obstructive’ adj3 disease).af) AND (steroid.af) AND (intravenous.af OR oral.af) AND ((acute OR emergen$ OR urgen$ OR decompensat$ OR sudden).af)

Search Outcome

One-hundred and seventy-four papers were found, of which two were considered relevant to the three-part question.

Relevant Paper(s)

Author, date and country

Patient group

Study type (level of evidence)

Outcomes

Key results

Study Weaknesses

de Jong et al,2007,Netherlands

210 patients over 40 years old with a >10 pack year history of smoking and evidence of airflow limitation defined as FEV1/FVC ratio <70% and FEV1<80% of predicted

Comment(s)

Although the use of steroids for the treatment of acute exacerbations of chronic obstructive airways disease is well supported by the available literature, the optimal dose, length of treatment and method of administration are not yet established, Walters et al. There are few data comparing oral versus intravenous administration of steroids, but the data available do not demonstrate any inferiority in efficacy for the oral form. Given the significant risk of adverse events associated with steroid use, the minimal effective dose for the least amount of time would be preferable.